MEDICARE: TESSA STURGEON M.S., CCC-SLP/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146009830	IL

General Provider Information

NPI Number	:	1235443284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSA STURGEON M.S., CCC-SLP/L

Provider Business Mailing Address
First Line	:	4220 N CLARK ST
Second Line	:	2
City	:	CHICAGO
State	:	IL
Zip	:	60613-1301
Country	:	US
Telephone Number	:	502-494-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 N CLARK ST
Second Line	:	2
City	:	CHICAGO
State	:	IL
Zip	:	60613-1301
Country	:	US
Telephone Number	:	502-494-7217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	10/20/2011

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Directions to “ TESSA STURGEON M.S., CCC-SLP/L” Practice Location

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